Even before the winds and rain toppled nearly everything standing, cholera was already here. It came down from the mountains, washing into the lives of the thousands who once lived above the river.

Now the only sign of life is in a makeshift clinic dealing with hundreds of suspected cholera cases, a small concrete building where just a few nurses contend with the swarms of patients arriving every hour.

There is only one public official left. The mayor was struck by cholera and left on foot to seek treatment hours away. One deputy died of the disease last week. Another fled, like so many others, to escape the ruin visited on the town of Rendel by Hurricane Matthew and its aftermath.

“Ninety percent of our village is gone,” said Eric Valcourt, a priest in the Roman Catholic parish that runs the clinic and a school that now serves as a shelter for those too sick or poor to leave. “Many left by foot to escape the disease and devastation. The rest died from cholera or the hurricane.”

But for many, the torment has only started. Cholera, the disease at the heart of Haiti’s last disaster, is being spread again by this one.

About 10,000 people have died and hundreds of thousands have been sickened since cholera first appeared in late 2010. Scientists say it was brought to Haiti by United Nations peacekeepers stationed at a base that leaked waste into a river. After years of deflecting blame, the United Nations this summer acknowledged “its own involvement” in the suffering Haiti has experienced from the disease.

Now, cholera is stalking the areas gutted by the hurricane, a long peninsula of coastal towns and mountain villages where clean water was already hard to find, long before the storm. Here in the remote town of Rendel, a grueling four-hour trek to the nearest paved road, the disease has spread to every crevice of this valley and the hills above.

“We are all at risk,” said the last official in Rendel, Pierre Cenel, the magistrate.

A father raced down the hill to the clinic with his young daughter draped over his back, clutching her legs, his face fixed in fear.

“She must have cholera,” the magistrate said. “He is running to save her life.”

Cholera was creeping through the mountains even before the hurricane, claiming the lives of untold numbers as its pushed toward town. First came the sick, who trudged down to Rendel, desperate for medical care.

Then, when the floods came, cholera was carried down by the water itself, which swept up fecal matter dumped on the hillsides, contaminating the river and other drinking supplies.

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A man and his daughters bathed in a river near Rendel that is believed to be contaminated and spreading cholera.Credit Meridith Kohut for The New York Times

Inexperience did the rest. Water unboiled or unchlorinated and poor hygiene meant the infections spread rapidly.

The town of Rendel and its surroundings, which once sheltered 25,000 people, are the epicenter of a potential disaster. Thousands have left on foot, forging a waist-high river that bends so often that it requires nine crossings along the way. The things they carry are all they have left: split bags of clothes and small livestock. They carry disease, too, destined for towns connected to the rest of the country by road.

Families trying to leave Rendel must deal with the river, which bends so often that it has nine crossings.Credit Meridith Kohut for The New York Times

One family braced for a river crossing, the youngest daughter in a purple dress with a pink sweater, clutching a live chicken in her arms.

“I don’t know what we will do, but we can’t live here,” said her father, Donald Augustin, 37, balancing a black suitcase on top of his head. “The people are dying of cholera.”

Those who remain bear witness to the slow release of misery. Heroic nurses care for patients splayed on the floor like rag dolls, some resting atop the improvised stretchers they arrived on. Patients vomit and defecate on the floor or into small yellow buckets, too sick to leave their stifling confines. The waste is emptied into an hole on the hill just behind the clinic, awaiting the next rainfall to overflow once again. The smell of bile and excrement stings the nostrils.

Patients come and go to escape the stench and the oppressive heat, while relatives risk disease to tend to their loved ones. Many refuse to come to the clinic at all, fearful of being blamed for the outbreak. Sick people midway through their recoveries are shown the door to make way for new patients. A single lantern is the only light for the nurses to work by during grueling 12-hour shifts.

Relatives risked disease to tend to their loved ones at the clinic in Rendel.Credit Meridith Kohut for The New York Times

A lowing child is rocked on her mother’s lap as an IV drip pumps fluids into her tiny arm. A young husband feeds his pregnant wife hot porridge, blowing over each spoonful as patients writhe beside and beneath them. A father kisses the ear of his 4-year-old son to soften the taste of saline solution.

“I spent the night here with her but the bed is too small for both of us so I slept outside and checked on her every hour,” said Jean Romit Cadet, 22, the young husband, handing the spoon to his wife and urging her to eat. “If I get sick, I get sick. I’m responsible for her.”

One morning this week, a rush of patients poured into the clinic, some carried on stretchers. A nurse tried to register each patient but lost track in the chaos, unable to take down everyone’s details.

A young girl entered the clinic and told the head nurse she was suffering from diarrhea.

“For how many days?” the nurse asked.

“Three,” the girl replied.

“Why are you only coming now?” the nurse demanded. “We need to hook you up to an IV.”

The girl refused.

“I’m not vomiting,” she yelled over her shoulder as she left the clinic.

Intravenous tubes dangled like translucent vines from the rafters of the clinic.Credit Meridith Kohut for The New York Times

The nurse turned to the crowd in the entrance of the clinic, a porch robbed of its roof by the storm. In its place hung a sagging blue tarp.

“This is the problem,” she told the crowd of patients, parents holding sick children and others laid out on the floor, their eyes lolling back into their heads. “She doesn’t want to use the IV because she isn’t vomiting. But that doesn’t mean she doesn’t have cholera.”

Another nurse approached and whispered that they were running out of needles for the IVs, which dangled like translucent vines from the rafters of the clinic. The nurse disappeared into a back room.

A patient seated on a bench near the entrance erupted from his seat and vomited over the edge of the porch, onto ground where people walk to and from the back of the building.

A mother and father tried to force-feed their 4-year-old son rehydration salts, sending the boy into fits. The child tried to bite the hand of an aide holding his arms. A nurse approached and asked the family if they had symptoms.

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A cholera patient was bathed with soap and water mixed with bleach.Credit Meridith Kohut for The New York Times

The mother, Osila Cominan, said it was her third day with diarrhea, but quickly added that she was not vomiting and did not need treatment.

“You should be on an IV, too,” the nurse said, before rushing to another patient vomiting on the floor.

In the town, citizens had set up a roadside cleaning station, a simple affair with a tank of chlorinated water that was sprayed onto the shoes and hands of those fleeing. With all the departures, the fear of carrying cholera to bigger cities was a real one.

The town itself was hollowed out. Those still here stood on what remained of front porches, mired in a state of shock, hoping the people would return.

The stasis was interrupted every so often by another patient heading to the clinic, staggering down the rocky paths or carried aloft by family. A few concrete homes provide the only reminder of the town that was. Lesser houses have been stacked into piles along with the trees and branches scattered by the storm.

Villagers carried Frisnel Louis to the clinic after he showed symptoms of cholera.Credit Meridith Kohut for The New York Times

“When you look around you, it’s like the end of the world,” said Joseph Kenso, 33. “Look around you. The disaster speaks for itself.”

One of the only buildings left is the clinic, a two-story structure that formerly served as a center for prenatal care.

The original cholera care center was destroyed in the hurricane. It had opened only a week before the storm, to treat people streaming in from the outbreak in the mountains above.

In the center of town, wearing just one flip-flop, Mr. Cenel, the magistrate, smiled ruefully at the town’s misfortune and his own, estimating that hundreds have died between the hurricane and the disease. But his math is like that of many: a reflection of the emotional toll, not an exact one.

“After a hurricane, if you don’t see someone for a few days, they are usually dead,” he said. Sixty percent of the town has now fled, he said.

“No! I disagree,” said a man standing in the magistrate’s front yard. “It’s at least 85 percent of the population gone.”

Some patients at the clinic were too sick to leave its stifling confines.Credit Meridith Kohut for The New York Times

Another man standing nearby said the people would return once they could rid the area of cholera. He was sure of it.

“They might,” said the magistrate, whose mother and father are among those who left. “They might.”

But how do you combat cholera in a place where people get their water from the river or surrounding springs, where disinfectant is a luxury?

One woman leaving the clinic with soiled sheets was stopped by a nurse, who asked her to drop them in a pile of clothing to be burned that night. The woman hesitated, throwing her hand over her eyes as she addressed the nurse.

“I can’t,” she said. “This is all I have left.”

The toll from cholera is unknowable. Most of the departed never make it to the clinic and get buried without any record.

“We don’t know how many have died in the surrounding community,” said another nurse, Marie Marguerite Bernadin, 42. “But we know most of the deaths occur outside of here.”

If the cases are caught early enough, the nurses explained, treatment is as simple as rehydration.

“They don’t come on time because for some of them it’s an embarrassment and they tried to hide the sick,” explained Alicia Hyppolite, 32, a nurse in the clinic.

A boy carried river water to what remained of his family’s home in Rendel.Credit Meridith Kohut for The New York Times

About an hour and a half north is the village of Delibarain, a hamlet near the mountain river that feeds the springs of Rendel. Before the hurricane, residents and officials said there were several deaths from cholera, or what they believed to be cholera, since there were no labs on hand to confirm the disease.

The first ones that residents and local leaders can remember were the members of the Vital family, five of whom died from the disease.

The dead were buried in graves without wrapping them in plastic, wearing gloves or taking the precautionary measures applied to cholera-infected bodies. Soon, even more people were infected. The rainy season spread the disease farther.

“They just placed them in the earth,” said Thomas Cyril, 47, who lives in the village and knew the family.

Prostrate on the floor were his brother, Faniel Cyril, and his cousin, Alicia Delcy, both of whom were showing symptoms of cholera. Faniel, barely conscious, reached out to grab the hand of Mrs. Delcy from time to time.